peds chapter 2

The nurse is teaching a family about the benefits of circumcising their male neonate. The parents decline this procedure. How does this decision reflect the use of the family-centered approach by the nurse? A. It empowers the family to make their own decision. B. It applies the ethical principle of beneficence. C. Education about circumcision is provided to both parents. D. Evidence-based research is presented to the parents about circumcism.

Answer: A Rationale: Family-centered care empowers the family to make their own decisions regarding care. The power of control becomes the family's, not the nurse's. This decision also takes into consideration the family's beliefs and culture. Beneficence is the act of being kind or helping someone. This term does not apply to this situation. Evidence-based information about circumcisim may have been used for teaching, but allowing the family empowerment to make decisions about their health care exemplifies the family-centered approach.

The nurse is caring for a 2-week-old newborn girl with a metabolic disorder. Which activity would deviate from the characteristics of family-centered care? A. softening unpleasant information or prognoses B. evaluating and changing the nursing plan of care C. collaborating with the child and family as equals D. showing respect for the family's beliefs and wishes

Answer: A Rationale: Family-centered care requires that the nurse provide open and honest information to the child and family. It is inappropriate to soften unpleasant information or prognoses. Evaluating and changing the nursing plan of care to fit the needs of the child and family, collaborating with them as equals, and showing respect for their beliefs and wishes are guidelines for family-centered care.

A nurse is preparing an in-service program for a group of newly hired nurses about trends in care for pregnant women. When describing events of the past decade, the nurse would state that the average length of stay in the hospital for vaginal births is: A. 24 to 48 hours or less. B. 72 to 96 hours or less. C. 48 to 72 hours or less. D. 96 to 120 hours or less.

Answer: A Rationale: Hospital stays for vaginal births have averaged 24 to 48 hours or less during the past decade and 72 to 96 hours or less for cesarean births.

A nurse working in the community is involved in providing primary prevention. Which intervention would be most appropriate to implement? A. teaching parents of toddlers about ways to prevent poisoning B. working with women who are victims of domestic violence C. working with clients at an HIV clinic to provide nutritional and CAM therapies D. teaching hypertensive clients to monitor blood pressure

Answer: A Rationale: Primary prevention involves preventing a disease or condition before it occurs, such as teaching parents of toddlers about poisoning prevention. Working with women who are victims of domestic violence, clients at an HIV clinic, or hypertensive clients are all examples of tertiary prevention, which is designed to reduce or limit the progression of a disease or condition.

A nurse is reading a journal article about the changes in health care delivery and funding that have occurred over the years. Which factor would the nurse expect to find as a current trend in maternal and child health care settings? A. increase in ambulatory care B. decrease in family poverty level C. increase in hospitalization of children D. decrease in managed care

Answer: A Rationale: The health care system has moved from reactive treatment strategies in hospitals to a proactive approach in the community, resulting in an increased emphasis on health promotion and illness prevention in the community through the use of community-based settings such as ambulatory care. Poverty levels have not decreased, and the hospitalization of children has not increased. Case management also is a primary focus of care.

The nurse needs to provide discharge education to a family to whom English is a second language and who will need to provide several skills daily for their child who has been diagnosed with a chronic illness. What is the best way for the nurse to provide this teaching? A. Provide teaching in short sessions B. Provide printed material with images of the skills C. Utilize videos of the skills to demonstrate D. Provide written materials in both English and the first language

Answer: A Rationale: The most important element when teaching this family will be to break the teaching into short sessions so the family is not overwhelmed with the information and can better comprehend the content. Adding video and written material is a good idea, but these should be provided after the teaching is completed and the parents have returned demonstrations of the skill. The written and visual resources will be good for the family when they have returned home and need further clarification or additional understanding.

3. The nurse is providing home care for a 6-year-old girl with multiple medical challenges. Which activity would be considered the tertiary level of prevention? A. arranging for a physical therapy session B. teaching parents to administer albuterol C. reminding parent to give a full course of antibiotics D. giving a DTaP vaccination at the proper interval

Answer: A Rationale: The tertiary level of prevention involves restorative, rehabilitative, or quality of life care such as arranging for a physical therapy session. Teaching parents to administer albuterol and reminding a parent to give the full course of antibiotics as prescribed are part of the secondary level of prevention, which focuses on diagnosis and treatment of illness. Giving a DTaP vaccination at the proper interval is an example of the primary level of prevention, which centers on health promotion and illness prevention.

The public health nurse is preparing a presentation for an adolescent group with the focus being on primary prevention topics. Which topics would the nurse include? Select all that apply. A. Nutrition guidelines B. Hygiene practices C. Sun protection routine D. Smoking cessation programs E. Sexually transmitted infections

Answer: A, B, C Rationale: The concept of primary prevention involves preventing the disease or condition before it occurs through health promotion activities, environmental protection, and specific protection against disease or injury. Its focus is on health promotion to reduce the person's vulnerability to any illness by strengthening the person's capacity to withstand physical, emotional, and environmental stressors. Secondary prevention is the early detection and treatment of adverse health conditions from smoking or STIs.

A nurse working in the neonatal intensive care unit assists a family during the discharge of the premature newborn. What would the nurse prioritize in assessing the family's preparedness to care for the newborn? Select all that apply. A. The family's knowledge of newborn care B. The mother's and the family's concerns C. The family's available support system D. The availability of day care by the family's home E. The family's health insurance benefit program

Answer: A, B, C Rationale: The nurse should assess the family's knowledge of positioning and handling of their infant, nutrition, hygiene, elimination, growth and development, immunizations needed, and recognition of illnesses. The nurse should identify knowledge deficiencies so that they can be addressed in the nurse's teaching plan. Targeting the mother's areas of concern will help the nurse focus on needed education. The nurse should also assess physical and emotional support for the new mother by asking questions about the availability of support.

A nurse is preparing to visit the home of a two-day postpartum client and her infant. Which assessments would the nurse expect to prioritize during the home visit? Select all that apply. A. a postpartum assessment B. assessment of the family members' well-being C. newborn nutritional assessment D. routine newborn exam E. socioeconomic family assessment F. community day care assessment

Answer: A, B, C, D Rationale: Postpartum care in the home environment usually includes monitoring the physical and emotional well-being of the family members; identifying potential or developing complications for the mother and newborn; newborn feeding; and instruction on pelvic floor exercises, nutrition, and self-hygiene care.

A nurse is providing preoperative instructions to a client undergoing an emergency cesarean birth. Which actions follow appropriate communication guidelines? Select all that apply. A. During the instructions, the nurse uses open-ended questions. B. The conversation is redirected while maintaining its focus. C. The client's feelings are addressed. D. The nurse does not acknowledge the emotions in the situation. E. The family's words are used to describe the necessary information. F. Only the correct medical terms are used when explaining the cesarean birth.

Answer: A, B, C, E Rationale: Good verbal communication skills are necessary. General guidelines for appropriate verbal communication include the following: Use open-ended questions that do not restrict the clients' answers; redirect the conversation to maintain focus; use reflection to clarify the parents' feelings; paraphrase the child's or parent's feelings to demonstrate empathy; acknowledge emotion; and demonstrate active listening by using the child's or family's own words.

A nurse educator is preparing a lecture for a group of students about the possible client indicators of poor health literacy. Which student statements would indicate that teaching was successful? Select all that apply. A. "Clients will have difficulty filling out registration forms." B. "They frequently have missed appointments." C. "There is a pattern of lack of follow-up with treatment." D. "Clients will report not be able to hear." E. "There is a pattern of history of medication errors." F. "Clients will ask many questions about their health situation."

Answer: A, B, C, E Rationale: Red flags that might indicate poor literacy skills include: difficulty filling out registration forms; frequently missed appointments; noncompliance and lack of follow-up with treatment regimens; history of medication errors; and avoiding asking questions for fear of looking "stupid." Reports of an inability to hear may be due to something else, like true hearing loss.

A nurse on a pediatric unit is asked by the mother of a young postoperative child, "What does atraumatic care mean?" Which responses by the nurse would be appropriate? Select all that apply. A. "Care on this unit attends to the distress experienced by children and their families." B. "Care that is provided minimizes the hospitalization stress." C. "Your child's care will prevent anxiety-provoking behaviors from occurring." D. "Attention will be paid to decreasing or preventing separation anxiety." E. "An early discharge will be planned so care can be given in the home."

Answer: A, B, D Rationale: Atraumatic care refers to the delivery of care that minimizes or eliminates the psychological and physical distress experienced by children and their families in the health care system. The key principles of atraumatic care include preventing or minimizing physical stressors, preventing or minimizing separation of the child from the family, and promoting a sense of control for family. Nurses must be alert for any situation that has the potential for causing distress and should be able to identify potential stressors. Nurses should minimize separation anxiety of the child from the family and should decrease the child's exposure to stressful situations in order to prevent or minimize pain and injury.

A nurse is preparing to teach insulin administration to a newly diagnosed diabetic adolescent and the adolescent's family. Which strategies would the nurse use to assist the client's learning? Select all that apply. A. Go slow and repeat information often. B. Use plain nonmedical language to explain procedures. C. Deliver the material in an educational lecture format. D. Teach the prioritized information. E. Use the accurate medical terms in the presentation.

Answer: A, B, D Rationale: Techniques that can help improve learning include: slow down and repeat information often; repeat important information at least four or five times; speak in conversational style using plain, nonmedical language; group information and teach it in small amounts using logical steps; and prioritize information first. Teach using an interactive, "hands-on" approach.

A hospital nurse is considering changing roles to become a home health nurse. What skill(s) will be important for this nurse to possess to be successful in the new role? Select all that apply. A. Be able to work with less structure B. Have good assessment skills C. Be knowledgeable about community resources D. Have good critical thinking skills E. Understand that not all environments will be desirable

Answer: A, B, D, E Rationale: The nurse providing home health care must understand that decisions will need to be made for care at the point of care. That means the nurse must have very good assessment and communication skills. The home health nurse also performs care that has to be individualized for the client and the environment. Thus, critical thing skills are essential. Equipment may not be available, so the nurse can improvise with what is available. The home health nurse must also understand that not every home the nurse visits will be a desirable environment. The nurse must make decisions based on safety for the client and the nurse. In the hospital setting, the nurse deals primarily with individual clients and has the advantage of having members of the health care team readily available. Hospitals tend to function with structure. Having structure is not always the case in the home environment. The nurse must be able to adapt to the immediate needs of the client in the situation. In the home setting, the nurse would not only be working with the client, but with the entire family. This role will require taking into consideration family issues, culture, and environmental threats. The new home health nurse would learn about community resources. This knowledge could be acquired over time and is not required to start in the new role.

The nurse is preparing for a public health campaign with a focus on current trends with family-centered care. What information would the nurse include in the presentation? Select all that apply. A. Family-centered care requires sensitivity to the client's and family's beliefs. B. The family should be assessed according to the relative importance of each member. C. Family-centered care promotes greater family decision-making abilities. D. The client's family is considered in health care to be an expert partnership. E. Family members should be addressed individually before being addressed collectively.

Answer: A, C, D Rationale: Family-centered care above all requires sensitivity to the client's and family's beliefs. This involves listening to the family's needs and a shift of the nurse's authoritarian role to the family to empower them to make their own decisions within the context of a supportive environment. One expert partnership that nurses can make is with the client's family. The philosophy of family-centered care recognizes the family as the constant.

The nurse would include which principle(s) of adult learner-centered care when preparing to teach a female client about medication compliance? Select all that apply. A. Client teaching may include the strategy of role playing. B. Client teaching strategies should focus on a lecture style. C. Adults learn best when they realize there is gap in their knowledge base. D. The best time for adults to learn is when it meets an immediate need for them. E. Client teaching should focus on the content not the process.

Answer: A, C, D Rationale: Teaching adults needs to focus more on the process than on the content. Adults are self-directed and value independence and want to learn on their own terms. Teaching strategies that include such concepts as role playing, demonstration, and self-evaluation are most helpful. Adults learn best when they perceive there is a gap in their knowledge base and want information to fill the gap. Adults learn best at a time when learning meets an immediate need. Adults value past experiences and beliefs.

A pregnant client tells her nurse that she is interested in arranging a home birth. After educating the client on the advantages and disadvantages of a home birth, which statement would indicate that the client understood the information? A. "I like having the privacy, but it might be too expensive for me to set up in my home." B. "I want to have more control, but I am concerned if an emergency would arise." C. "It is safer because I will have a midwife." D. "The midwife is trained to resolve any emergency, and she can bring any pain meds."

Answer: B Rationale: Home births have many advantages, such as having more control over the birth, being the least expensive option, creating a good relationship with a midwife, and having more flexibility in the comfort of your home. However, the limited availability of pain medication and danger to the mother and baby if an emergency arises are two of the main disadvantages.

6. The nurse would recommend the use of which supplement as a primary prevention strategy to prevent neural tube defects in the future offspring of pregnant women? A. calcium B. folic acid C. vitamin C D. iron

Answer: B Rationale: Prevention of neural tube defects in the offspring of pregnant women via the use of folic acid is an example of a primary prevention strategy. Calcium, vitamin C, and iron have no effect on the prevention of neural tube defects.

11. A nurse is teaching a local women's group about women's health care and changes that have occurred. When describing women's health care today, which statement would the nurse likely include? A. Women spend 50 cents of every dollar spent on health care. B. Women make almost 80% of all health care decisions. C. Women are still the minority in the United States. D. Men use more health services than women.

Answer: B Rationale: Women make almost 80% of all health care decisions (those related to caregiver, mother, client); they represent the majority of the population; they spend 66 cents of every health care dollar; and they use more health services than men, with 7 of every 10 most frequently performed surgeries being specific to women.

A nurse is working at a community prenatal drop-in clinic. Which actions best reflect the principles of family nursing within this clinic? Select all that apply. A. The clients and their families are assessed for adherence to federal health guidelines. B. Health promotion education activities are planned for the clients and their families. C. The clients and their families are included in all decision-making collaborations. D. The nurse would seek other health care provider input to plan care. E. The client is viewed as the ultimate decision maker.

Answer: B, C, D Rationale: When implementing family-centered care, nurses seek other caregiver input. These suggestions and advice are incorporated into the client's plan of care as the nurse counsels and teaches the family appropriate health care interventions. Health promotion activities are offered to the client and family. The nurses partner with various experts to provide high-quality and cost- effective care. One expert partnership that nurses can make is with the client's family. The client and family are the health care decision makers.

After teaching a group of nursing students about family-centered care, which statement made by the students would best indicate that the teaching was successful? A. "Family-centered care recognizes the health of the client." B. "Family-centered care is a component of health care." C. "Family-centered care recognizes the concept of family as the constant." D. "Family-centered care is one part of a system."

Answer: C Rationale: Family-centered care recognizes the concept of the family as the constant. The health and functioning ability of the family influences and impacts the health of the client and other members of the family. It recognizes the client and the family as the source of control and a full partner in their care.

A nurse is educating a client about a care plan. Which question would be appropriate to assess whether the client is learning? A. "Did you graduate from high school, and how many years of schooling did you have?" B. "Do you have someone in your family who would understand this information?" C. "Many people have trouble remembering information; is this a problem for you?" D. Would you prefer that the primary care provider give you more detailed medical information?"

Answer: C Rationale: It is appropriate to ask the client if the client will have trouble remembering the information. Many clients have this problem. It removes any judgment or stereotypes regarding education level, ability to understand, or learning skills. Avoid giving information that uses a lot of medical language or jargon, and use a simple, conversational style.

A public health nurse is preparing to visit the home of teenage parents with a new infant. Which action would be the priority? A. Determine the family's willingness for home visits. B. Prepare a schedule of follow-up visits. C. Review previous home visits to validate interventions. D. Review the family record to assess if the visit is necessary.

Answer: C Rationale: It is essential to review previous interventions to eliminate unsuccessful ones. Checking with previous home visit narratives will validate interventions. It would be necessary to communicate with previous nurses to ask questions and clarify. The other actions would not be the priority.

Which action would the nurse include in a primary prevention program in the community to help reduce the incidence of HIV infection? A. Provide treatment for clients who test positive for HIV. B. Monitor viral load counts periodically. C. Educate clients on how to practice safe sex. D. Offer testing for clients who practice unsafe sex.

Answer: C Rationale: Primary prevention involves preventing disease before it occurs. Therefore, educating clients about safe sex practices would be an example of a primary prevention strategy. Providing treatment for clients who test positive for HIV, monitoring viral loads periodically, and offering testing for clients practicing unprotected sex are examples of secondary preventive strategies, which focus on early detection and treatment of adverse health conditions.

The nurse is preparing the discharge plan for a woman whose newborn requires ventilatory support at home. Which action by the nurse would be most appropriate to do when assuming the role of discharge planner? A. Confer with the client's parents. B. Teach new self-care skills to the client. C. Determine if there is a need for back-up power. D. Discuss coverage with the insurance company.

Answer: C Rationale: The nurse should establish if there is a need for back-up power during discharge planning. Conferring with a woman's parents and dealing with insurance companies are case management activities. Teaching self-care skills are activities associated with the nurse as an educator.

The nurse is providing care to a pregnant woman who speaks a different language from that of the nurse. When communicating with this client, the nurse demonstrates best practice by which action? A. speaking to the client in a loud voice at a slow pace B. standing close to the client while using a strong emphatic tone C. having a family member communicate the information to the client D. arranging for an interpreter to be present during any communication

Answer: D Rationale: The nurse should arrange for an interpreter when communicating with a client who speaks another language. Speaking loudly, standing close to the client, and speaking emphatically would be of little benefit if the client does not understand the spoken language. Additionally, it can be interpreted as threatening to the client. Having a family member communicate the information to the client is inappropriate, violates client confidentiality (if the client has not given permission for that member to have the information), and does not ensure that the client will receive the correct information.

The nurse is obtaining a health history from a parent who has brought the infant to the clinic for a well-baby check-up. Which statement by the nurse indicates the most appropriate way to demonstrate empathy for the parent's concerns? A. "I am sure you must be very tired with your baby wanting to nurse every two hours during the night." B. "Your concerns about your infant's growth are valid but your infant is growing well." C. "I believe I heard you say your infant is not doing well. Can you explain why you feel this way?" D. "Is there any other reason you brought your infant to the clinic today other than immunizations?"

answer: A Rationale: The way to demonstrate empathy through verbal communication is by paraphrasing the client's expressed feelings. This demonstrates the nurse heard what the client said and is being empathetic to the situation. Telling the parent not to worry about the infant's growth is a nontherapeutic and it also belittles the parent's concern. Asking the parent to explain one's feelings is using reflection to clarify the parent's feelings. Asking the parent why he or she brought the infant to clinic is a use of an open-ended question, which allows the parent to expand on the original statement.

An oncology nurse is preparing a plan of care for a young father newly diagnosed with lung cancer. What action would be the nurse's priority? A. Complete the application for emergency financial assistance. B. Suggest that community members be sought to assist with child care. C. Recommend that the father join a community cancer support group. D. Teach the family how to navigate the health care system.

answer: D Rationale: Family-centered care refers to the collaborative partnership among the individual, family, and caregivers to determine the plan of care, gather information, offer support, and formulate plans for health care. It is generally understood to be an approach in which clients and their families are considered integral components of the health care decision making and delivery processes. The other options do not include the family in the process.